title: Peri-operative third party red blood cell transfusion in renal transplantation and the risk of antibody-mediated rejection and graft loss.
abstract: Historic red blood cell transfusion (RBCT) may induce anti-HLA antibody which, if donor specific (DSA), is associated with increased antibody-mediated rejection (AMR). Whether post-operative RBCT influences this risk is unknown. We examined the RBCT history in 258 renal transplant recipients stratified according to prevalent recipient HLA antibody (DSA, Non-DSA or No Antibody). AMR occurred more frequently in patients who received RBCT both pre and post transplant compared with all other groups (Pre+Post-RBCT 21%, Pre-RBCT 4%, Post-RBCT 6%, No-RBCT 6%, HR 4.1 p=0.004). In the 63 patients who received Pre+Post-RBCT, 65% (13/20) with DSA developed AMR compared with 0/6 in the Non-DSA group and 2/37 (5%) in the No-Antibody group (HR 13.9 p<0.001). In patients who received No-RBCT, Pre-RBCT or Post-RBCT there was no difference in AMR between patients with DSA, Non-DSA or No-Antibody. Graft loss was independently associated with Pre+Post-RBCT (HR 6.5, p=0.001) AMR (HR 23.9 p<0.001) and Non-AMR (6.0 p=0.003) after adjusting for DSA and delayed graft function. Re-exposure to RBCT at the time of transplant is associated with increased AMR only in patients with preformed DSA, suggesting that RBCT provides additional allostimulation. Patients receiving Pre+Post-RBCT also had an increased risk of graft loss independently of AMR or DSA. Both pre and post procedural RBCT in renal transplantation is associated with modification of immunological risk and warrants additional study.
authors.affiliation: Department of Clinical Immunology, PathWest, Royal Perth Hospital, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Australia.
authors.forename: Samantha
authors.initials: S
authors.lastname: Fidler
authors.forename: Ramyasuda
authors.initials: R
authors.lastname: Swaminathan
authors.forename: Wai
authors.initials: W
authors.lastname: Lim
authors.forename: Paolo
authors.initials: P
authors.lastname: Ferrari
authors.forename: Campbell
authors.initials: C
authors.lastname: Witt
authors.forename: Frank T
authors.initials: FT
authors.lastname: Christiansen
authors.forename: Lloyd J
authors.initials: LJ
authors.lastname: D'Orsogna
authors.forename: Ashley B
authors.initials: AB
authors.lastname: Irish
mesh_terms: D000328:Adult; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology / Q000276:immunology*; D006680:HLA Antigens / Q000097:blood / Q000276:immunology; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: AMR; Antibody mediated rejection; BPAR; DGF; DSA; Donor-specific antibody (DSA); Kidney transplantation; MFI; Peri-operative transfusion; RBCT; SAB; antibody-mediated rejection; biopsy proven acute rejection; cPRA; calculated panel reactive antibody; delayed graft function; donor specific antibodies; mean fluorescence intensity; red blood cell transfusion; single antigen bead